Office Use: Event Name Date: Approved: Yes No. City: State Zip: Primary Contact Phone (d): Phone (c): Phone (f): Offsite Location (specify):

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1 Doylestown Township 425 Wells Road, Doylestown PA Phone: Fax: Website: (onsite events) (offsite events) SPECIAL EVENT PERMIT APPLICATION Complete all questions and return application form with all required and supplemental attachments to Doylestown Township at least 60 days prior to the event. Park System Events: $25 application fee plus fees as outlined in the Township s fee schedule. All Other Events: $150 or $250 if including fireworks. Other fees may apply Office Use: Event Name Date: Approved: Yes No 1: APPLICANT INFORMATION The Primary Contact is the person who is to be contacted regarding the application or event. Primary Contact Name: Primary Contact Address: City: State Zip: Primary Contact Phone (d): Phone (c): Phone (f): Primary Contact Event Name: Type of Event: Are you representing a Host Organization? Is this organization non profit? No Yes Yes, if so list name, address and phone below No Is this organization private? No Yes Organization s Name: Purpose of Event Organization s Address: Organization Contact Person: Organization s Phone (d): Phone (c): Phone (f): 2: GENERAL EVENT INFORMATION Township Park System: Central Park Turk Park Sauerman Park Other (specify) Offsite Location (specify): Event Type: (check allapplicable) Walk Bike Tour Sporting Event/Tournament Wedding Concert Festival/Fair Run Bike Race Rally/Demonstration Block Party Exhibition Parade Fireworks Other (describe): Date of Event (primary date): Event Duration: Dates the event will be in operation Rain Date (not guaranteed for park events): Starting Date: Ending Date: Day: Day: Date: / / 20 Date: / / 20 Attendance (all inclusive): Include event organizers, staff, volunteers, participants, spectators, etc. Hours of Operation: Actual event hours. If event lasts more than two days attach additional hours of operation with application. Total Attendance Estimate: Start End Anticipated Vehicles: Day 1 : am pm : am pm Parking Shuttle: No Yes Day 2 : am pm : am pm Site Arrival: The start time represents arrival on the site for setup and preparation. If same as actual event start, enter starting date and time of event as above. Site Departure: The ending time represents departure from the site following dismantle and clean up. If same as actual event end, enter ending date and time as above. Starting Date: / / Ending Date: / / Will an registration/entry fee be charged: No Yes If Yes, how much: $ Time: : am pm Time: : am pm Is this Event: Charitable For Profit Private Other (describe )

2 3. EVENT DESCRIPTION Is this a fixed or moving event (i.e., run, bike ride, etc.)? Fixed Moving, if so specify dispersing area and route and diagram Event Description (provide a description of the proposed event including activities, entertainers, vendors, facilities. etc.) 4. SITE PLAN / DIAGRAM Attachment Required (all events require a site map of affected areas): Fixed show placement of the following features as applicable. Moving show placement of the following features applicable. Must show full route/course and start/finish points. Check in / Gate(s) and/or Entrance(s) Comfort Stations (portable toilets) Stages or other performance areas Dumpsters, trash and recycling containers Tents and/or Trailers Other (specify): Command Center / Headquarters Vendor booths Money rooms Fencing Food & Beverage Concessions Street crossings and barricades Security/emergency First Aid / Medical Station(s) Sign/Banner placement Other event components not listed Fire Extinguishers Attachment Required Route If this is a moving event or will cross any roadways please provide a detailed route description from start (dispersing area) to finish. Dispersing area: Finish Location: 5. EVENT FEATURES Event Features/Amenities (check all that apply): Park System: Requires coordination with the Director of Parks and Recreation. Offsite: Requires coordination with the Code Enforcement Director. Note: Prior to submission contact the appropriate department(s) relative to supplemental requirements. Twp. Park Facilities (1) Temporary Signs (2) Amplified Sound (1, 2) Street Closing/Crossing (4) Portable Toilets (1, 2) Raffles (requires Small Games of Chance permit) Temp. Electric/Generator (2) Emer. Medical Service (3) Fireworks (3) Tent/Other Rental Equipment (1. 2) Security (4) Inflatable Apparatus (1, 2) Food Concessions (1, 2, 6) Showmobile (1) Staging/Construction (1,2,5) Street Closing/Crossing (4) Carnival Rides/Games (1,2) Other (specify): Other (specify): Event Features Key Must follow up with: 1 P&R Department 2 Code Enforcement Office 3 Fire Marshal 4 Police Department 5 Director of Operations (Public Works) 6 Bucks County Board of Health

3 6. TENTS / TEMPORARY STRUCTURES Tents/temporary structures require a waiver (from the P&R Dept.) for all special events within the park system. Tent and/or temporary structures must be shown on all site plans. Flame retardant certification is required for all temporary membrane structures (tents, inflatable s, etc.) Number of Tents: Dimensions of Tents: Number of Temporary Structures: Dimensions of Temporary Structures: Name/Address of Supplier: Emergency Contact: Phone: Day of: 7. COMFORT STATIONS / PORTA POTTIES The applicant is responsible for addressing the needs for their individual events. All Park System events will require a minimum of one (1) accessible unit for every 150 people. Park system restrooms are intended to meet the needs of general park users and are not intended to serve as supplemental facilities. Offsite/private events must provide portable restroom facilities at your event unless you can substantiate the sufficient availability of both accessible and non accessible facilities in the immediate area of the offsite event site that will be available to the public during your event. Ten percent (10%) of restroom facilities must meet local, state, and federal accessibility requirements. No less than one (1) accessible restroom should be placed in each location designated for restrooms facilities and located on a level area not to exceed a 2% cross slope in any direction. If a single restroom unit is placed in a location, it must be accessible. An accessible route to each portable restroom must be provided. The number of portable toilets can be determined based on your estimated peak time attendance. Your portable sanitation service contractor will help you in planning properly for any event. Number of Units: Delivery on site (date/time): Removal from site (date/time): Cleaning Schedule (if multiple days): Name/Address of Supplier: Emergency Contact: Phone : Day of: 8. ELECTRICAL SERVICE / EXTENDED HOURS OF OPERATION If the event requires electrical power or occurs during darkness or in a dark structure, lighting, emergency lighting and illuminated exit signage will be required. Electrical permit application required for 120v circuits and generators. Show location of generators and fixtures. Indicate type of fixture on plan, i.e., Exit sign, emergency illumination, power to vendor s tents. All electrical installations to comply with the PA UCC, NEC 2008 and must be inspected by a PA Dept. of L&I certified 3 rd party electrical inspector. A list of inspectors is available on the Township website under Code Enforcement Guidelines. Temporary lighting that affects neighboring properties is to be shielded. How will electrical service be supplied: Generator Public Utilities Both Power and lighting Plan A written description of the proposed power sources and lighting details must be indicated on site plan. Attach an Electrical Permit if required. 9. FOOD/HEALTH SAFETY The applicant may allow concessionaires to be present in conjunction with the event. All food vendors are to have a permit, if required, from Bucks County Health Department. Indicate location of each food vendor on the site plan and provide a copy of their Health Department Permit. Attached Not Applicable 20 foot separation is required between membrane structures that contain open flames (cooking). Adequate drinking water is to be available. Indicate how this is provided. Animal exhibits and petting zoos require a Health Department permit, provide copies with the application. Indicate location of required hand washing stations on site plan. Who is responsible for ensuring hand washing stations remain operative?

4 10. EMERGENCY MEDICAL PLAN Compliance with the International Fire Code 2010 is required At a minimum, local emergency services must be notified of your event and copy of notice provided to the Township. If attendance is over 5,000 people, an ambulance and fire truck may need to be on scene with backup available should either have to leave the event. If attendance is over 25,000 people an onsite emergency treatment center will be required and two ambulances to be available. Consult with PA Dept. of Health for their requirements. For all events an on site First Aid location is to be established. Details of these arrangements must be provided. See the PA Title 28: Chapter 1013 for Special Event Emergency Medical Requirements On Site Emergency Medical Service: Yes No N/A Standby Notified If N/A, please explain reason: If yes, Agency: Agency Phone: 11. FIRE SAFETY The Fire Marshal will require a general site inspection prior to the start of the event. The Doylestown Township Fire Marshal must review and approve plans for: first aid and/or emergency medical services, emergency vehicle access, use of an open flame, use of fireworks or pyrotechnics, handling of vehicle fuel, cooking facilities, location of power sources, availability and location of on site fire suppression equipment, occupancy and spacing of tables or enclosures and the use of tents, air supported structures, canopies or any fabric shelters. Indicate all required features on the site plan. At a minimum, extinguishers to be located at each exit to an assembly structure and at each cooking or open flame location. NO SMOKING signs to be posted in all structures. Smoking is strictly prohibited in all Doylestown Township Parks. Indicate Fire Hydrant locations on plan. Indicate emergency vehicle access to site, access road around site to be 20 feet wide. If any emergency vehicles are to be on site for the event, indicate location of vehicles on the site plan. Call the local ambulance squad and Fire Department to notify them of the dates and times of the event so that they are aware of its scope. 12. EVENT SAFETY & SECURITY The Township may require staffing of uniformed/non uniformed police officers to be on duty throughout the event. The applicant will be responsible for the cost incurred for these services. Event Organizers are required to provide a safe and secure environment for the event. A detailed plan for crowd control and security is required as part of the Special Event Application. There must be an Event Control Center. Indicate on plan, and it must be clearly identified for attendees. Who is in charge at the event? Provide contact information for the Event Director. All employees and volunteers assisting with the event must be fully aware of the procedure, and have the ability to contact the Event Director as well as notify all three municipal emergency service agencies; Fire, Police and Ambulance. Give details of the training to be provided to the event staff. There must be a PA system or method of communicating with all attendees in the event of an emergency. Give details of the emergency evacuation plan. Where is a location for lost children? (Event Control Center?) Will there be sufficient staff at the event for the expected number of attendees? Give details of how security is addressed, and details of how traffic and parking will be directed on site. What are the numbers of these staff and what are their qualifications, or how will they be trained? Off site traffic or pedestrian control will have to be approved by the Doylestown Township Police Department. Is a secure area required for dignitaries/vip s? Show location. Required (all events) please describe your Event Safety/Security Plan.

5 13. PARKING & TRAFFIC CONTROL The Township may require staffing of uniformed/non uniformed police officers to be on duty throughout the event. The applicant will be responsible for the cost incurred for these services. Patron parking at Township facilities shall be limited to areas designated for parking only. In situations where sufficient parking is not available, the event organizer is required to provide a plan to transport/shuttle participants from an off site area to the event. Event organizers will be required to provide adequate volunteers (wearing proper safety equipment) for the purpose of directing patron parking. Event organizers shall be required to submit a parking plan for all vehicles associated with the event and participant parking. Required for Park System events please describe your Event Safety/Security Plan. 14. TRASH & RECYCLING Required (All events): The applicant shall be responsible for leaving the facility in an as good or better condition than the site was found prior to the start of the event. Doylestown Township requires that recyclables generated at the event (i.e., aluminum cans, glass, cardboard, etc.) be recycled. The applicant is responsible for the removal of all trash, litter, debris, etc. associated with the event. The applicant must make arrangements to supply an adequate number of trash and recycling receptacles and to remove trash and other event debris from the park/facility immediately upon conclusion of the event. Failure to perform adequate clean up and/or should damage occur to Township property or facilities, funds will be held back from the posted security deposit and/or the applicant will be billed at full cost recovery rates for supplies, cleanup, repair. Placement of all dumpsters must be approved by the township prior to placement. Please describe your plan for cleanup and removal of waste during and after your event: We will provide: Number of Trash Receptacles Number of Dumpsters Number of Recycling Containers Sanitation Service: Yes No Company Name: Phone: Equipment Setup: Date: Time: Equipment Pickup: Date: Time: 15. MITIGATION OF IMPACT Neighborhood Impact (required for all events): The event organizers are required to include mitigation measures for negative consequences imposed on others by the event. Event notification must reflect the date(s), day(s), time(s), location(s), type of activities taking place at the event and any potential impact such as traffic delay. Where applicable, notification must give detour or alternate route information if normal access is affected. A draft sample of the notice and proposed list of recipients must be attached to the application. No event should unduly impact the surrounding neighbors for an extended period of time. Formal approval of the event must be received from the Township prior to start of any promotion or advertisement of the event. Road Races in/around Central Park: Organizers are required to provide written notice delivered directly to surrounding neighbors and must include organization/event name, type of event, date, time of event, route and anticipated time/nature of impact and contact information Electronic notification and/or event flyers are not acceptable. A draft sample of the notification (i.e., letter, postcard, etc.) and proposed list of recipients must be attached to the application. Required for all Park System events: Marketing/media plan. Notification plan for neighboring residential properties. A copy of the notification letter must be enclosed with this application. included To be forwarded no later than / /

6 16. WEATHER Weather can play a major role in the success, failure or safety at an event. Adequate advance planning is essential. Required for all Park System events: Provide a brief description of your rain policy relative to this event. Specify preparations in place for bad weather? For example vehicle towing from temporary parking should mud develop. Give details. Rain dates may be requested for Township Park use but are not guaranteed. Dates can only be held as long as no other application is received. Securing a guaranteed rain date the applicant will incur additional fees. The applicant is responsible to notify all applicable township officials, vendors, contractors, etc. of cancellation/postponement. If Township personnel and/or equipment is dispatched due to lack of notification, the applicant will be held responsible for all additional costs. 17. SUPPORT STAFF You may request and/or the Township may require staffing of uniformed/non uniformed staff to be on duty throughout the event. The applicant will be responsible for the cost incurred for these services. Required (Park System events): No staff support is requested however, it is understood and acknowledged that support staff may be required and will be at the applicant s expense. Check if applicable. I am requesting Township support staff. Yes No Describe: I am requesting Police support Yes No Describe: 18. INSURANCE Before final permit approval will be granted, the applicant must provide an original and current certificate of general liability insurance including bodily injury and property damage in the amount of $1,000,000 per occurrence and aggregate of $2,000,000 The certificate must name Doylestown Township as an additional insured. The applicant may also be required to include other affiliated organizations, required by the township, as additional insured : This may include but is not limited to Doylestown Fire Department or other organizations whose assistance may be required. Coverage must be maintained for the duration of the event. The Township of Doylestown reserves the right to request a copy of the entire insurance policy. Name of Insurance Carrier: Agent s Name: Address: City: State: Zip: Business Phone: ( ) PLANNING MEETING Required (all events): One or more planning meetings with the Township Officials are required. The meeting attendees, depending upon the size and type of special event, should be from the following, as appropriate for the event: Promoter/Sponsor Twp. Emergency Management Coordinator Law Enforcement Fire Department Fire Police Fire Marshal Emergency Medical Services Bucks County Health Department. Twp. Director of Code Enforcement Twp. Public Works Department County/State Officials At this meeting: The Incident Commander / Event Coordinator for the event will be appointed. This individual coordinates the event and serves as the ultimate decision maker. The following will also be appointed/identified: Incident Commander Chief Fire Officer Chief Security Officer Chief Emergency Medical Officer The Incident Command System ground rules to be followed are NIMS/ICS Safety Officer And others as appropriate

7 20. Fees & Charges The Doylestown Township Fee Schedule can be downloaded at either or Park System events (any Township park or other municipally owned property) Application fee $25 due at time of application submission Use fees as established and in accordance with the published Doylestown Township Fee Schedule. Due upon receipt of invoice Security Deposit Determined by the nature and scope of the event (minimum of $500) Police Support fees will be invoiced separately by the Police Department. Other fees as applicable. Offsite Events (all other events) Fees as established and in accordance with the published Doylestown Township Fee Schedule. Due at time of application. Electrical Permit application as required Other fees as applicable 21. SUBMISSION CHECKLIST Site Plan document attached Route diagram attached (I.e., run, walk, road crossings etc.) Parking Plan document attached Security Plan document attached Insurance Certificate document attached Other (as required) 22. AFFIDAVIT OF APPLICANT I certify that the information contained in the foregoing application is true and correct to the best of my knowledge and belief that I have read, understand and agree to abide by the rules and regulations governing the proposed Special Event and/park System use. I understand that this application is made subject to the rules and regulations established by the Township of Doylestown. Applicant agrees to comply with all other requirements of the Township, County, State, Federal Government, and any other applicable entity, which may pertain to the use of the Event Venue and the conduct of the Event. I agree to abide by these rules and further certify that I on behalf of the Host Organization am also authorized to commit that organization, and therefore agree to be financially responsible for any costs and fees that may be incurred by or on behalf of/to the Event to the Township of Doylestown. I further certify that I will comply with all Local, County, State and Federal disability access requirements applicable to the event. Compliance with the Township s permit requirements does not exempt the applicant from any additional requirements that may be imposed by Local, County, State or Federal Laws. Print Name of Applicant/Host Organization: Signature of Applicant: Date: 23. HOLD HARMLESS AGREEMENT The Special Event applicant or president or designee of the sponsoring organization(s) (hereafter called permittee ) agrees to reimburse the Township of Doylestown (hereafter called Township ) for all loss incurred by it in repairing or replacing damage to Township property proximately caused by the permittee, its officers, employees, agents, monitors, or any persons attending or forming the event who were, or should have been, under the permittee s control. I certify that the information contained in the foregoing application is true and correct to the best of my knowledge and belief, that I have read, understand and agree to abide by the rules and regulations governing the proposed Special Event as set forth by Doylestown Township and I understand that this application is made subject to the rules and regulations established by the Doylestown Township Board of Supervisors. I agree to abide by these rules, and further certify that I, on behalf of the organization, am also authorized to commit that organization, and therefore agree to be financially responsible for any cost and fees that may be incurred by or on behalf of the event to the Township of Doylestown. I, through the signing of this application, indemnify, hold harmless, and defend the Township of Doylestown and its agents, officials and employees from all suits and actions, including reasonable attorneys fees and all costs of litigation and judgment of every name and description against the Township as a result of loss, damage, or injury to any person or property by reason of any action or omission by the event organizer. Name of Applicant (print): Signature of Applicant: Title: Date: